Atrial cardiopathy is associated with dementia later in life: neurology today

Article coming soon

A new study found a link between dementia and atrial cardiopathy. Independent experts recommend that neurologists study and promote both heart and brain health.

Older adults with atrial cardiomyopathy may be at increased risk of developing dementia, according to findings published in the Aug. 16 issue Journal of the American Heart Association.

“There is growing evidence that the way we think about dementia is a bit more complex than we initially thought, and that vascular contributions to cognitive impairment are very important,” said study lead author Michelle Johansen. MD, PhD, Assistant Professor of Neurology at Johns Hopkins University School of Medicine and Associate Faculty at Johns Hopkins Bloomberg School of Public Health.

study details

dr Johansen and her colleagues at Johns Hopkins prospectively studied 5,078 older adults in the Atherosclerosis Risk in Communities (ARIC) Study living in four US communities: Washington County, MD; Forsyth County, NC; northwest suburbs of Minneapolis, MN; and Jackson, MS. The participants did not have dementia when they were recruited for the study in the late 1980s. Specifically, researchers collected data at three different visits between 2011 and 2019 to determine if participants had atrial cardiomyopathy and dementia at the last two.

The mean age of the sample was 75 years, 59 percent were women and 21 percent were black. About one-third (34 percent) had atrial cardiomyopathy, and 763 of the total sample developed dementia during the median follow-up of 6.12 years.

Atrial cardiopathy was associated with an increased risk of dementia (adjusted HR = 1.35; 95 percent CI, 1.16-1.58), and the association was stronger when participants met at least two of the criteria for atrial cardiopathy (adjusted HR = 1.54; 95 percent). CI, 1.25-1.89).

The researchers excluded subjects with atrial fibrillation and the association stood; (adjusted HR = 1.31; 95 percent CI, 1.12-1.55), and the same was true when participants with stroke were excluded (adjusted HR = 1.28; 95 percent CI, 1.09 −1.52), the investigators wrote. The researchers found that atrial fibrillation produces 4 percent of the effect of atrial cardiopathy on dementia (p=.005) and stroke-mediated 9 percent of the effect (p=.048).

dr Johansen noted that increased inflammation is associated with both atrial dysfunction and dementia, but said no study provides solid answers as to how atrial cardiopathy can lead to subsequent dementia.

“Could it be because the left atrium is unhealthy that the blood is pooling there and you’re not getting enough blood to the brain as a result? Or do you have microembolizations that don’t cause stroke but may contribute to stroke? That’s what we’re trying to figure out, and it’s probably a combination of factors,” she said.

The heart-brain relationship

“This study convincingly demonstrates that left atrial cardiopathy is an important potential independent contributor to the risk of cognitive decline,” said Heart Nexus Research Program MD at the University of Ottawa Heart Institute.

dr Edwards noted that the findings have important implications for neurologists because, although anticoagulant therapy has been shown to reduce the risk of cognitive impairment and dementia, current risk assessment and treatment decision tools are primarily based on the onset of overt atrial fibrillation either before or at the time of AF stroke. “However, these data tell us that cardiac changes, which often precede the onset of atrial fibrillation, may be useful in identifying those who are at high risk of cognitive decline,” she said.

Based on the results, Dr. Edwards suggests that neurologists should consider atrial cardiopathy and comorbid heart disease when assessing cognitive risk and that individuals with markers of left atrial cardiopathy may be an important group to target for screening or potential anticoagulation if randomized and clinically implemented Studies will show its benefit in this population.

It may also be up to healthcare providers to educate their patients about the link between heart health and brain health, and how reducing vascular risk can benefit their heart and cognitive health, she added.

However, the heart isn’t the only organ that contributes to cognitive function, according to Costantino Iadecola, MD, Anne Parrish Titzell Professor of Neurology and director and chair of the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine.

“The landscape of cognitive impairment is rapidly becoming diverse and multifaceted. There is growing evidence that peripheral organs contribute significantly to the risk of dementia, not just the heart but also the kidney and, as recently suggested by Dr. Neal Parikh demonstrated here at Weill Cornell, including subclinical liver disease,” noted Dr. Iadecola.

He added that efforts to reduce the risk of dementia have begun to include the contribution of factors outside the brain, “which can exacerbate neurovascular and neurodegenerative pathologies, with the heart being a prominent target.”

dr Iadecola said cardiologists and primary care physicians who treat patients with vascular risk factors can use drugs to help maintain heart and vascular system health, for example to control high blood pressure, diabetes and hyperlipidemia, and to encourage patients to make lifestyle changes For example, reduce dangerous behaviors such as smoking, sedentary lifestyles and excessive alcohol consumption.

Julie A. Schneider, MD, Deborah R. and Edgar D. Jannotta Presidential Professor of Pathology and Neurological Sciences and Director of the Alzheimer’s Research Center at Rush University Medical Center agreed.

“Although there is not yet enough information to recommend prevention strategies for dementia in patients with atrial cardiomyopathy, it is important that patients know that what is good for your heart is also good for your brain. For example healthy diet, physical activity, moderation of blood pressure and blood sugar.”

She pointed out the strong connection between heart health and brain health. “As noted in this manuscript, stroke is a known risk factor for dementia and atrial fibrillation, a common heart condition in the elderly, is a known risk factor for stroke. This study suggests that in addition to atrial fibrillation, atrial cardiomyopathy, which occurs more frequently than atrial fibrillation and is itself a risk factor for atrial fibrillation, is also a risk factor for dementia in individuals without a history of stroke or atrial fibrillation.”

Sudha Seshadri, MD, FAAN, director of the Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases at UT Health San Antonio and principal investigator of the Framingham Heart Study at Boston University, said there is a clear and long-standing finding that heart disease affects the brain badly Blood flow to the brain due to heart failure, with overt and covert ischemia presenting as embolic stroke, transient ischemic attack, or increased white matter hyperintensity in individuals with atrial fibrillation, since vascular risk factors such as hypertension and diabetes can affect both major arteries of the heart and the Brain. “We have thus shown that coronary calcium is a risk factor for stroke. A disrupted blood-brain barrier and pericyte dysfunction may increase amyloid deposition.”

dr Seshadri stressed the importance of screening. “I think neurologists could get an inexpensive electrocardiogram (as part of a routine evaluation for subjective or mild cognitive impairment,” said Dr. Seshadri. “Also, our neurologists should be encouraged to consider testing for subclinical disease in other organ systems.” Step in the right direction,” she added.

disclosure

dr Johansen had no information. dr Schneider reportedreceive consultancy fees forAlnylum Pharmaceuticals and Cerveautechnologies.